Healthcare Provider Details

I. General information

NPI: 1952898439
Provider Name (Legal Business Name): RUBEN ANTONIO APONTE MIRANDA RVS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CALLE BALDORIOTY
YABUCOA PR
00767-3423
US

IV. Provider business mailing address

HC 5 BOX 5373
YABUCOA PR
00767-9670
US

V. Phone/Fax

Practice location:
  • Phone: 787-349-2107
  • Fax:
Mailing address:
  • Phone: 787-349-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: